This invention relates to regimens of administering compounds which are antagonists of the progesterone receptor in combination with a progestin, an estrogen, or both.
Intracellular receptors (IR) form a class of structurally related genetic regulators known as xe2x80x9cligand dependent transcription factorsxe2x80x9d (R. M. Evans, Science, 240, 889, 1988). The steroid receptor family is a subset of the IR family, including progesterone receptor (PR), estrogen receptor (ER), androgen receptor (AR), glucocorticoid receptor (GR), and mineralocorticoid receptor (MR).
The natural hormone, or ligand, for the PR is the steroid progesterone, but synthetic compounds, such as medroxyprogesterone acetate or levonorgestrel, have been made which also serve as ligands. Once a ligand is present in the fluid surrounding a cell, it passes through the membrane via passive diffusion, and binds to the IR to create a receptor/ligand complex. This complex then translocates to the nucleus of the cell where it binds to a specific gene or genes present in the cell""s DNA. Once bound to a specific DNA sequence the complex modulates the production of the mRNA and protein encoded by that gene.
A compound that binds to an IR and mimics the action of the natural hormone is termed an agonist, whilst a compound which inhibits the effect of the hormone is an antagonist. PR agonists (natural and synthetic) are known to play an important role in the health of women. PR agonists are used in birth control formulations, typically in the presence of an ER agonist. ER agonists are used to treat the symptoms of menopause, but have been associated with a proliferative effect on the uterus (in non-hysterectomized women) which can lead to an increased risk of uterine cancers. Co-administration of a PR agonist reduces/ablates that risk. PR antagonists may also be used in contraception. In this context they may be administered alone (Ulmann, et al, Ann. N.Y. Acad. Sci., 261, 248, 1995), in combination with a PR agonist (Kekkonen, et al, Fertility and Sterility, 60, 610, 1993) or in combination with a partial ER antagonist such as tamoxifen (WO 96/19997 A1, Jul. 4, 1996).
PR antagonists may also be useful for the treatment of hormone dependent breast cancers (Horwitz, et al, Horm. Cancer, 283, pub: Birkhaeuser, Boston, Mass., ed. Vedeckis) as well as uterine and ovarian cancers. PR antagonists may also be useful for the treatment of non-malignant chronic conditions such as fibroids (Murphy, et al, J. Clin. Endo. Metab., 76, 513, 1993) and endometriosis (Kettel, et al, Fertility and Sterility, 56, 402, 1991).
PR antagonists may also be useful in hormone replacement therapy for post menopausal patients in combination with a partial ER antagonist such as tamoxifen (U.S. Pat. No. 5,719,136). PR antagonists such as Mifepristone have also been shown to have bone sparing effects in rodents, and as such may be useful in the treatment of osteoporosis associated with the menopause (Barengolts, et al, Bone, 17, 21, 1995). PR antagonists, such as mifepristone and onapristone, have been shown to be effective in a model of hormone dependent prostate cancer, which may indicate their utility in the treatment of this condition in men (Michna, et al, Ann. N.Y. Acad. Sci., 761, 224, 1995).
Jones, et al, (U.S. Pat. No. 5,688,810) described the PR antagonist dihydroquinoline 1. 
Jones, et al, described the enol ether 2 (U.S. Pat. No. 5,693,646) as a PR ligand. 
Jones, et al, described compound 3 (U.S. Pat. No. 5,696,127) as a PR ligand. 
Zhi, et al, described lactones 4, 5 and 6 as PR antagonists (J. Med. Chem, 41, 291, 1998). 
Zhi, et al, described the ether 7 as a PR antagonist (J. Med. Chem, 41, 291, 1998). 
Combs, et al., disclosed the amide 8 as a ligand for the PR (J. Med. Chem., 38, 4880, 1995). 
Perlman et. al., described the vitamin D analog 9 as a PR ligand (Tet. Letters, 35, 2295, 1994). 
Hamann,et al, described the PR antagonist 10 (Ann. N.Y. Acad. Sci., 761, 383, 1995). 
Chen, et al, described the PR antagonist 11 (Chen, et al, POI-37, 16th Int. Cong. Het. Chem, Montana, 1997). 
Kurihari, et. al., described the PR ligand 12 (J. Antibiotics, 50, 360, 1997). 
U.S. Pat. No. 5,521,166 (Grubb) teaches cyclophasic hormonal regimens comprising an antiprogestin and a progestin wherein the progestin is administered in the alternating presence and absence of an antiprogestin. The disclosed regimens also provide for use of an estrogen for a period of from 2-4 days to prevent breakthrough bleeding.
This invention provides combination therapies and dosing regimens utilizing antiprogestational agents in combination with one or more progestational agents. This invention further provides methods of treatment and dosing regimens further utilizing in combination with these antiprogestins and progestins, an estrogen, such as ethinyl estradiol.
These regimens and combinations may be administered to a mammal to induce contraception or for the treatment and/or prevention of secondary amenorrhea, dysfunctional bleeding, uterine leiomyomata, endometriosis; polycystic ovary syndrome, carcinomas and adenocarcinomas of the endometrium, ovary, breast, colon, prostate. Additional uses of the invention include stimulation of food intake. The uses herein for the treatment and/or prevention of the conditions or diseases described above includes the continuous administration or periodic discontinuation of administration of the invention to allow for minimization of effect dose or minimization of side effects or cyclic menstrual bleeding.
The use of this invention for contraception includes administration, preferably orally, to a female of child bearing age an antiprogestin in combination with an estrogen or progestin or both. These administration regimens are preferably carried out over 28 consecutive days, with a terminal portion of the cycle containing administration of no progestins, estrogens or anti-progestins.
The progestins of these combinations may be administered alone or in combination with an estrogen for the first 14 to 24 days of the cycle, the progestins being administered at a dosage range equal in progestational activity to about 35 xcexcg to about 150 xcexcg levonorgestrel per day, preferably equal in activity to from about 35 xcexcg to about 100 xcexcg levonorgestrel per day. An antiprogestin may then be administered alone or in combination with an estrogen for a period of 1 to 11 days to begin on any cycle day between day 14 and 24. The anti-progestin in these combinations may be administered at a dose of from about 2xcexcg to about 50 xcexcg per day and the estrogen may be administered at a dose of from about 10 xcexcg to about 35 xcexcg per day. In an oral administration, a package or kit containing 28 tablets will include a placebo tablet on those days when the antiprogestin or progestin or estrogen is not administered.
In a preferred embodiment of this invention, the progestins of this invention may be administered alone or in combination with estrogen for the initial 18 to 21 days of a 28-day cycle, followed by administration of an antiprogestin, alone or in combination with an estrogen, for from 1 to 7 days.
The estrogen to be used in the combinations and formulations of this invention is preferably ethinyl estradiol.
Progestational agents useful with this invention include, but are not limited to, levonorgestrel, norgestrel, desogestrel, 3-ketodesogestrel, norethindrone, gestodene, norethindrone acetate, norgestimate, osaterone, cyproterone acetate, trimegestone, dienogest, drospirenone, nomegestrol, or (17-deacetyl)norgestimate. Among the preferred progestins for use in the combinations of this invention are levonorgestrel, gestodene and trimegestone.
Examples of orally administered regimens of this invention over a 28 day cycle include administration of a progestational agent solely for the first 21 days at a daily dose equal in progestational activity to from about 35 to about 100 xcexcg of levonorgestrel. An antiprogestin compound of this invention may then be administered at a daily dose of from about 2 to 50 mg from day 22 to day 24, followed by no administration or administration of a placebo for days 25 to 28. It is most preferred that the daily dosages of each relevant active ingredient be incorporated into a combined, single daily dosage unit, totaling 28 daily units per 28-day cycle.
In another regimen, a progestational agent may be coadministered for the first 21 days at a daily dose equal in progestational activity to from about 35 to about 150 xcexcg levonorgestrel, preferably equal in activity to from about 35 to about 100 xcexcg levonorgestrel, with an estrogen, such as ethinyl estradiol, at a daily dose range of from about 10 to about 35 xcexcg. This may be followed as described above with an antiprogestin administered at a daily dose of from about 2 to 50 mg from day 22 to day 24, followed by no administration or administration of a placebo for days 25 to 28.
Still another regimen within the scope of this invention will include coadministration from days 1 to 21 of a progestational agent, the progestational agent, preferably levonorgestrel, being administered at a daily dose equal in progestational activity to from about 35 to about 100 xcexcg levonorgestrel, and an estrogen, such as ethinyl estradiol, at a daily dose range of from about 10 to about 35 xcexcg. This will be followed on days 22 to 24 by coadministration of an antiprogestin (2 to 50 mg/day) and an estrogen, such as ethinyl estradiol, at a daily dose of from about 10 to about 35 xcexcg. From day 25 to day 28, this regimen may be followed by no administration or administration of a placebo.
This invention also kits or packages of pharmaceutical formulations designed for use in the regimens described herein. These kits are preferably designed for daily oral administration over a 28-day cycle, preferably for one oral administration per day, and organized so as to indicate a single oral formulation or combination of oral formulations to be taken on each day of the 28-day cycle. Preferably each kit will include oral tablets to be taken on each the days specified, preferably one oral tablet will contain each of the combined daily dosages indicated.
According to the regimens described above, one 28-day kit may comprise:
a) an initial phase of from 14 to 21 daily dosage units of a progestational agent equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably equal in progestational activity to about 35 to about 100 xcexcg levonorgestrel;
b) a second phase of from 1 to 11 daily dosage units of an antiprogestin compound of this invention, each daily dosage unit containing an antiprogestin compound at a daily dosage of from about 2 to 50 mg; and
c) optionally, a third phase of an orally and pharmaceutically acceptable placebo for the remaining days of the cycle in which no antiprogestin, progestin or estrogen is administered.
A preferred embodiment of this kit may comprise:
a) an initial phase of 21 daily dosage units of a progestational agent equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably equal in progestational activity to about 35 to about 100 xcexcg levonorgestrel;
b) a second phase of 3 daily dosage units for days 22 to 24 of an antiprogestin compound of this invention, each daily dosage unit containing an antiprogestin compound at a daily dosage of from about 2 to 50 mg; and
c) optionally, a third phase of 4 daily units of an orally and pharmaceutically acceptable placebo for each of days 25 to 28.
Another 28-day cycle packaging regimen or kit of this invention comprises:
a) a first phase of from 18 to 21 daily dosage units of a progestational agent equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably equal in activity to from about 35 to about 100 xcexcg levonorgestrel, and, as an estrogen, ethinyl estradiol at a daily dose range of from about 10 to about 35 xcexcg; and
b) a second phase of from 1 to 7 daily dosage units of an antiprogestin of this invention at a daily dose of from about 2 to 50 mg; and
c) optionally, an orally and pharmaceutically acceptable placebo for each of the remaining 0-9 days in the 28-day cycle in which no progestational agent, estrogen or antiprogestin is administered.
A preferred embodiment of the kit described above may comprise:
a) a first phase of 21 daily dosage units of a progestational agent equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably equal in activity to from about 35 to about 100 xcexcg levonorgestrel, and, as an estrogen, ethinyl estradiol at a daily dose range of from about 10 to about 35 xcexcg; and
b) a second phase of 3 daily dosage units for days 22 to 24 of an antiprogestin administered at a daily dose of from about 2 to 50 mg; and
c) optionally, a third phase of 4 daily dose units of an orally and pharmaceutically acceptable placebo for each of days 25 to 28.
A further 28-day packaged regimen or kit of this invention comprises:
a) a first phase of from 18 to 21 daily dosage units, each containing a progestational agent of this invention at a daily dose equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably equal in activity to from about 35 to about 100 xcexcg levonorgestrel, and ethinyl estradiol at a daily dose range of from about 10 to about 35 xcexcg;
b) a second phase of from 1 to 7 daily dose units, each daily dose unit containing an antiprogestin of this invention at a concentration of from 2 to 50 mg; and ethinyl estradiol at a concentration of from about 10 to about 35 xcexcg; and
c) optionally, an orally and pharmaceutically acceptable placebo for each of the remaining 0-9 days in the 28-day cycle in which no progestational agent, estrogen or antiprogestin is administered.
A preferred embodiment of the package or kit just described comprises:
a) a first phase of 21 daily dosage units, each containing a progestational agent of this invention at a daily dose equal in progestational activity to about 35 to about 150 xcexcg levonorgestrel, preferably from about 35 to about 100 xcexcg levonorgestrel, and ethinyl estradiol at a daily dose range of from about 10 to about 35 xcexcg;
b) a second phase of 3 daily dose units for days 22 to 24, each dose unit containing an antiprogestin of this invention at a concentration of from 2 to 50 mg; and ethinyl estradiol at a concentration of from about 10 to about 35 xcexcg; and
c) optionally, a third phase of 4 daily units of an orally and pharmaceutically acceptable placebo for each of days 25 to 28.
In each of the regimens and kits just described, it is preferred that the daily dosage of each pharmaceutically active component of the regimen remain fixed in each particular phase in which it is administered. It is also understood that the daily dose units described are to be administered in the order described, with the first phase followed in order by the second and third phases. To help facilitate compliance with each regimen, it is also preferred that the kits contain the placebo described for the final days of the cycle. It is further preferred that each package or kit comprise a pharmaceutically acceptable package having indicators for each day of the 28-day cycle, such as a labeled blister package or dial dispenser packages known in the art.
In this disclosure, the terms anti-progestational agents, anti-progestins and progesterone receptor antagonists are understood to be synonymous. Similarly, progestins, progestational agents and progesterone receptor agonists are understood to refer to compounds of the same activity.
These dosage regimens may be adjusted to provide the optimal therapeutic response. For example, several divided doses of each component may be administered daily or the dose may be proportionally increased or reduced as indicated by the exigencies of the therapeutic situation. In the descriptions herein, reference to a daily dosage unit may also include divided units which are administered over the course of each day of the cycle contemplated.
Compounds of this invention which may be used as the anti-progestational agents in the kits, methods and regimens herein include those of the Formula 1: 
wherein:
A and B are independent substituents selected from S, CH or N;
Provided that when A is S, B is CH or N; provided that when Bis S, A is CH or N;
and A and B cannot both be CH;
and when A and B both equal N, one N may be optionally substituted with an C1to C6 alkyl group;
R1 and R2 are independent substituents selected from the group of H, C1 to C6 alkyl, substituted C1 to C6 alkyl, C2 to C6 alkenyl, substituted C2 to C6 alkenyl, C2 to C6 alkynyl, substituted C2 to C6 alkynyl, C3 to C8 cycloalkyl, substituted C3 to C8 cycloalkyl, aryl, substituted aryl, heterocyclic, substituted heterocyclic, CORA, or NRBCORA;
or R1 and R2 are fused to form:
a) an optionally substituted 3 to 8 membered spirocyclic alkyl ring, preferably a 3 to 6 membered spirocyclic alkyl ring; or
b) an optionally substituted 3 to 8 membered spirocyclic alkenyl ring, preferably a 3 to 6 membered spirocyclic alkenyl ring; or
c) an optionally substituted 3 to 8 membered spirocyclic ring containing one to three heteroatoms selected from O, S and N, preferably a 3 to 6 membered spirocyclic ring containing one to three heteroatoms;
RA is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted aryl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
RB is H, C1 to C3 alkyl, or substituted C1 to C3 alkyl;
R3 is H, OH, NH2, C1 to C6 alkyl, substituted C1 to C6 alkyl, C3 to C6 alkenyl, substituted C1 to C6 alkenyl, alkynyl, or substituted alkynyl, or CORC;
RC is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted aryl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
R4 is a trisubstituted benzene ring containing the substituents X, Y and Z as shown below, 
X is selected from halogen, CN, C1 to C3 alkyl, substituted C1 to C3 alkyl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 thioalkyl, substituted C1 to C3 thioalkyl, C1 to C3 aminoalkyl, substituted C1 to C3 aminoalkyl NO2, C1 to C3 perfluoroalkyl, 5 or 6 membered heterocyclic ring containing 1 to 3 heteroatoms, CORD, OCORD, or NRECORD;
RD is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted aryl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
RE is H, C1 to C3 alkyl, or substituted C1 to C3 alkyl;
Y and Z are independent independently selected from H, halogen, CN, NO2, C1 to C3 alkoxy, C1 to C3 alkyl, or C1 to C3 thioalkyl; or
R4 is a five or six membered ring with 1, 2, or 3 heteroatoms from the group including O S, SO, SO2 or NR5 and containing one or two independent substituents from the group including H, halogen, CN, NO2 and C1 to C3 alkyl, C1 to C3 alkoxy, C1 to C3 aminoalkyl, CORF, or NRGCORF;
RF is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted aryl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
RG is H, C1 to C3 alkyl, or substituted C1 to C3 alkyl;
R5 is H, or C1 to C3 alkyl;
W is O or a chemical bond
or a pharmaceutically acceptable salt thereof.
Among the preferred anti-progestational compounds for use with this invention are those of Formula I wherein:
A and B are independent substituents S, CH or N,
provided that when A is S, B is CH or N; and
when B is S, A is CH or N; and
A and B cannot both be CH; and
when A and B both equal N, one N may be optionally substituted with an C1 to C6 alkyl group;
R1 is H, C1 to C6 alkyl, substituted C1 to C6 alkyl, C3 to C8 cycloalkyl, substituted C3 to C8 cycloalkyl, aryl, substituted aryl, heterocyclic, substituted heterocyclic, CORA, or NRBCORA;
R2 is H, C1 to C6 alkyl, substituted C1 to C6 alkyl, C2 to C6 alkenyl, substituted C2 to C6 alkenyl, C2 to C6 alkenyl, substituted C2 to C6 alkynyl, C3 to C8 cycloalkyl, substituted C3 to C8 cycloalkyl, aryl, substituted aryl, heterocyclic, substituted heterocyclic, CORA, or NRBCORA;
or R1 and R2 are fused to form:
a) an optionally substituted 3 to 8 membered spirocyclic alkyl ring; or
b) an optionally substituted 3 to 8 membered spirocyclic alkenyl ring; or
c) an optionally substituted 3 to 8 membered spirocyclic ring containing one to three heteroatoms selected from the group of O, S and N;
RA is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted aryl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
RB is H, C1 to C3 alkyl, or substituted C1 to C3 alkyl;
R3 is H, OH, NH2, C1 to C6 alkyl, substituted C1 to C6 alkyl, C3 to C6 alkenyl, substituted C1 to C6 alkenyl, alkynyl, or substituted alkynyl, or CORC;
RC is H, C1 to C4 alkyl, substituted C1 to C4 alkyl, aryl, substituted aryl, C1 to C4 alkoxy, substituted C1 to C4 alkoxy, C1 to C4 aminoalkyl, or substituted C1 to C4 aminoalkyl;
R4 is a trisubstituted benzene ring containing the substituents X, Y and Z as shown below: 
X is taken from the group including halogen, CN, C1 to C3 alkyl, substituted C1 to C3 alkyl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 thioalkyl, substituted C1 to C3 thioalkyl, C1 to C3 aminoalkyl, substituted C1 to C3 aminoalkyl, NO2, C1 to C3 perfluoroalkyl, 5-membered heterocyclic ring containing 1 to 3 heteroatoms, CORD, OCORD, or NRECORD;
RD is H, C1 to C3 alkyl, substituted C1 to C3 alkyl, aryl, substituted andyl, C1 to C3 alkoxy, substituted C1 to C3 alkoxy, C1 to C3 aminoalkyl, or substituted C1 to C3 aminoalkyl;
RE is H, C1 to C3 alkyl, or substituted C1 to C3 alkyl;
Y and Z are independent substituents taken from the group including H, halogen, CN, NO2, C1 to C3 alkoxy, C1 to C3 alkyl, or C1 to C3 thioalkyl; or
R4 is a five or six membered ring with 1, 2, or 3 heteroatoms from the group including O S, SO, SO2 or NR5 and containing one or two independent substituents from the group including H, halogen, CN, NO2 and C1 to C3 alkyl, or C1 to C3 alkoxy;
R5is H or C1 to C3 alkyl;
W is O or a chemical bond
or a pharmaceutically acceptable salt thereof.
Further preferred progesterone receptor antagonists are those of Formula I wherein:
A and B are independent substituents from the group including S, CH or N;
provided that when A is S, B is CH or N; and
when B is S, A is CH or N; and
A and B cannot both be CH;
R1xe2x95x90R2 and are selected from the group which includes C1 to C3 alkyl, substituted C1 to C3 alkyl, or spirocyclic alkyl constructed by fusing R1 and R2 to form a 3 to 6 membered spirocyclic ring;
R3 is H, OH, NH2, C1 to C6 alkyl, substituted C1 to C6 alkyl, or CORC;
RC is H, C1 to C4 alkyl, or C1 to C4 alkoxy;
R4 is a disubstituted benzene ring containing the substituents X and Y as shown below: 
X is selected from the group including halogen, CN, C1 to C3 alkoxy, C1 to C3 alkyl, NO2, C1 to C3 perfluoroalkyl, 5 membered heterocyclic ring containing 1 to 3 heteroatoms, or C1 to C3 thioalkyl;
Y is a substituent on the 4xe2x80x2 or 5xe2x80x2 position selected from the group of H, halogen, CN, NO2, C1 to C3 alkoxy, C1 to C4 alkyl, or C1 to C3 thioalkyl; or
R4 is a five membered ring with the structure shown below: 
U is O, S, or NR5;
R5 is H, or C1 to C3 alkyl, or C1 to C4 CO2alkyl;
Xxe2x80x2 is selected from halogen, CN, NO2, C1 to C3 alkyl or C1 to C3 alkoxy;
Yxe2x80x2 is H or C1 to C4alkyl; or
R4 is a six membered ring with the structure: 
X1 is N or CX2;
X2 is halogen, CN or NO2;
W is O or a chemical bond; or a pharmaceutically acceptable salt thereof.
The anti-progestational compounds of this invention may contain an asymmetric carbon atom and some of the compounds of this invention may contain one or more asymmetric centers and may thus give rise to optical isomers and diastereomers. While shown without respect to stereochemistry in Formula I, II, and III, the present invention includes such optical isomers and diastereomers; as well as the racemic and resolved, enantiomerically pure R and S stereoisomers; as well as other mixtures of the R and S stereoisomers and pharmaceutically acceptable salts thereof.
The term xe2x80x9calkylxe2x80x9d is used herein to refer to both straight- and branched-chain saturated aliphatic hydrocarbon groups having from one to 8 carbon atoms, preferably from 1 to 6 carbon atoms; xe2x80x9calkenylxe2x80x9d is intended to include both straight- and branched-chain alkyl group having from 2 to 8 carbon atoms, preferably 2 to 6 carbon atoms, with at least one carbon-carbon double bond; xe2x80x9calkynylxe2x80x9d group is intended to cover both straight- and branched-chain alkyl group having from 2 to 8 carbon atoms, preferably 2 to 6 carbon atoms, with at least one carbon-carbon triple bond.
The terms xe2x80x9csubstituted alkylxe2x80x9d, xe2x80x9csubstituted alkenylxe2x80x9d, and xe2x80x9csubstituted alkynylxe2x80x9d refer to alkyl, alkenyl, and alkynyl as just described having one or more substituents from the group including halogen, CN, OH, NO2, amino, aryl, heterocyclic, substituted aryl, substituted heterocyclic, alkoxy, aryloxy, substituted alkyloxy, alkylcarbonyl, alkylcarboxy, alkylamino, arylthio. These substituents may be attached to any carbon of alkyl alkenyl, or alkynyl group provided that the attachment constitutes a stable chemical moiety.
The term xe2x80x9carylxe2x80x9d is used herein to refer to an aromatic system which may be a single ring or multiple aromatic rings fused or linked together as such that at least one part of the fused or linked rings forms the conjugated aromatic system. The aryl groups include but not limited to phenyl, naphthyl, biphenyl, anthryl, tetrahydronaphthyl, phenanthryl.
The term xe2x80x9csubstituted arylxe2x80x9d refers to aryl as just defined having one or more substituents from the group including halogen, CN, OH, NO2, amino, alkyl, cycloalkyl, alkenyl, alkynyl, alkoxy, aryloxy, substituted allyloxy, alkylcarbonyl, alkylcarboxy, alkylamino, or arylthio.
The term xe2x80x9cheterocyclicxe2x80x9d is used herein to describe a stable 4- to 7-membered monocyclic or a stable multicyclic heterocyclic ring which is saturated, partially unsaturated, or unsaturated, and which consists of carbon atoms and from one to four heteroatoms selected from the group including N, O, and S atoms. The N and S atoms may be oxidized. The heterocyclic ring also includes any multicyclic ring in which any of above defined heterocyclic rings is fused to an aryl ring. The heterocyclic ring may be attached at any heteroatom or carbon atom provided the resultant structure is chemically stable. Such heterocyclic groups include, for example, tetrahydrofuran, piperidinyl, piperazinyl, 2-oxopiperidinyl, azepinyl, pyrrolidinyl, imidazolyl, pyridyl, pyrazinyl, pyrimidinyl, pyridazinyl, oxazolyl, isoxazolyl, morpholinyl, indolyl, quinolinyl, thienyl, furyl, benzofuranyl, benzothienyl, thiamorpholinyl, thiamorpholinyl sulfoxide, and isoquinolinyl.
The term xe2x80x9csubstituted heterocyclicxe2x80x9d is used herein to describe the heterocyclic just defined having one or more substituents selected from the group which includes halogen, CN, OH, NO2, amino, alkyl, substituted alkyl, cycloalkyl, alkenyl, substituted alkenyl, alkynyl, alkoxy, aryloxy, substituted alkyloxy, alkylcarbonyl, alkylcarboxy, alkylamino, or arylthio. The term xe2x80x9calkoxyxe2x80x9d is used herein to refer to the OR group, where R is alkyl or substituted alkyl. The term xe2x80x9caryloxyxe2x80x9d is used herein to refer to the OR group, where R is aryl or substituted aryl. The term xe2x80x9calkylcarbonylxe2x80x9d is used herein to refer to the RCO group, where R is alkyl or substituted alkyl. The term xe2x80x9calkylcarboxyxe2x80x9d is used herein to refer to the COOR group, where R is alkyl or substituted alkyl. The term xe2x80x9caminoalkylxe2x80x9d refers to both secondary and tertiary amines wherein the alkyl or substituted alkyl groups may be either same or different and the point of attachment is on the nitrogen atom. The term xe2x80x9cthioalkylxe2x80x9d is used herein to refer to the SR group, where R is alkyl or substituted alkyl. The term xe2x80x9chalogenxe2x80x9d refers to Cl, Br, F, and I element.
The anti-progestin compounds of this invention can be prepared following the Schemes illustrated below:
A. Methods for synthesizing the thiophene cyclocarbamate compounds depicted in Scheme 1 are described below: 
Thus the amino thiophene ester 2 was prepared according to a literature procedure involving the Gewald reaction (see Comprehensive Heterocyclic Chemistry II. A Review of the Literature 1982-1995. A. R. Katritsky et al. Vol. 2 page 639), i.e. the reaction of a suitably substituted aromatic acetaldehyde with sulfur and methyl cyanoacetate in refluxing methanol (Scheme 1). Reaction of the 2-amino group with a suitable chloroformate or carbonate affords the protected amine 3. This can be accomplished by allowing 2 to react with a chloroformate or carbonate derivative such as methyl chloroformate, ethyl chloroformate, allyl chloroformate, 2-(trimethylsilyl)ethyl chloroformate or di-tert-butyldicarbonate in a solvent such as benzene, toluene, xylene, dichloromethane, tetrahydrofuran or pyridine. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Treatment of the protected amino compound 3 with an organo-metallic reagent such as a Grignard reagent, an alkyl or aryl-zinc reagent, an alkyl or aryl lithium reagent in an inert solvent (tetrahydrofuran, diethylether) under an inert atmosphere (nitrogen or argon) at a suitable temperature from 0xc2x0 C. up to reflux temperature of the solvent will then provide the tertiary alcohol 4. Compound 4 may then be subjected to basic conditions to effect ring closure to give the cyclocarbamate derivative 5. Suitable conditions would involve treatment of 4 with a base such as potassium hydroxide in a solvent such as ethanol or potassium t-butoxide in a solvent such as tetrahydrofuran. The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
Alternatively the carbamate protecting group present in 4 may be removed under conditions appropriate for its removal to afford 6 (Scheme 2). Subsequent ring closure of 6 with a reagent such as phosgene, carbonyldiimidazole or dimethyl carbonate in an appropriate solvent (tetrahydrofuran, dichloromethane, benzene, etc.) also will provide access to 5. 
Alternatively, compound 4 may be dehydrated to afford the isopropene derivative 7 (Scheme 3). Suitable conditions for the dehydration would be the use of a reagent such as acetic anhydride, methanesulfonyl chloride, p-toluenesulfonyl chloride or trifluoromethane sulfonyl chloride or anhydride, in a solvent such as pyridine, tetrahydrofuran, dichloromethane or benzene. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Exposure of 7 to acidic conditions would then afford ring closure to give 5. Suitable conditions would be the use of an acid such as p-toluenesulfonic acid, methanesulfonic acid or camphorsulfonic acid in a solvent such as dichloromethane, benzene, toluene or tetrahydrofuran. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
An alternative route to 5 is shown in Scheme 4. Treatment of the previously described compound 8 (M. Sugiyama, T. Sakamoto, K. Tabata, K. Endo, K. Ito, M. Kobayashi, H. Fukiumi, Chem. Pharm. Bull., 37(8): 2091 (1989)) with an organo-metallic reagent such as a Grignard reagent, an alkyl or aryl zinc reagent, an alkyl or aryl lithium reagent in an inert solvent (tetrahydrofuran, diethylether) under an inert atmosphere (nitrogen or argon) at a suitable temperature from 0xc2x0 C. up to reflux temperature of the solvent will then provide the tertiary alcohol 9. Compound 9 may then be subjected to basic conditions to effect ring closure to give the cyclocarbamate derivative 10. Suitable conditions would involve treatment of 10 with a base such as potassium hydroxide in a solvent such as ethanol or potassium t-butoxide in a solvent such as tetrahydrofuran. The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. Compound 10 may then be converted to the brominated derivative 11. Suitable conditions would be treatment with bromine or N-bromosuccinimide in a solvent such as dichloromethane, tetrahydrofuran or acetic acid. The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent in the presence of an additive such as silica gel. Subsequent reaction of 11 with an aryl or heteroaryl boronic acid, boronic acid anhydride or trialkyl stannane then provides access to the desired biaryl compound 5. The reaction can be carried out in a solvent such as acetone, ethanol, benzene, toluene or tetrahydrofuran, under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent, in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate. 
Alternatively, 10 (Scheme 5) may be treated at low temperature with a reagent such as an alkyl lithium or lithium amide in an inert solvent such as tetrahydrofuran, and then converted to a boronic acid 12 (M=B(OH)2) under the action of trimethyl or triisopropyl borate, or into a stannane via reaction with trimethyltin chloride or bis(trimethyltin). Subsequent reaction of 12 with an aryl or heteroaryl bromide or iodide in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate, would then effect conversion into the desired thiophene cyclocarbamate 5.
B. Methods for synthesizing the thiophene cyclocarbamate compounds depicted in Scheme 6 are described below: 
The amino thiophene compounds 15 (Scheme 6) are prepared according to a literature procedure (Comprehensive Heterocyclic Chemistry II. A Review of the Literature 1982-1995. A. R. Katrisky et al., Vol. 2, page 639) which involves treating a suitably substituted aromatic methyl ketone 13 with phosphorus oxychloride in N,N-dimethyl formamide to afford the chloro cyano olefin derivative 14. Allowing 14 to react with methyl mercaptoacetate in methanol containing sodium methoxide affords the key aminothiophene carboxylate starting material. Reaction of the 2-amino group with a suitable chloroformate or carbonate affords the protected amine 16. This can be accomplished by allowing 15 to react with a chloroformate or carbonate derivative such as methyl chloroformate, ethyl chloroformate, allyl chloroformate, 2-(trimethylsilyl)ethyl chloroformate or di-tert-butyldicarbonate in a solvent such as benzene, toluene, xylene, dichloromethane, tetrahydrofuran or pyridine. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Treatment of the protected amino compound 16 with an organo-metallic reagent such as a Grignard reagent, an alkyl or aryl-zinc reagent, an alkyl or aryl lithium reagent in an inert solvent (tetrahydrofuran, diethylether) under an inert atmosphere (nitrogen or argon) at a suitable temperature from 0xc2x0 C. up to reflux temperature of the solvent will then provide the tertiary alcohol 17. Compound 17 may then be subjected to basic conditions to effect ring closure to give the cyclocarbamate derivative 18. Suitable conditions would involve treatment of 4 with a base such as potassium hydroxide in a solvent such as ethanol or potassium t-butoxide in tetrahydrofuran. The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
Alternatively the carbamate protecting group present in 17 may be removed under conditions appropriate for its removal to afford 19 (Scheme 7). Subsequent ring closure of 19 with a reagent such as phosgene, carbonyldiimidazole or dimethyl carbonate in an appropriate solvent (tetrahydrofuran, dichloromethane, benzene, etc.) also will provide access to 18. 
Alternatively, compound 17 may be dehydrated to afford the isopropene derivative 20 (Scheme 8). Suitable conditions for the dehydration would be the use of a reagent such as acetic anhydride, methanesulfonyl chloride, p-toluenesulfonyl chloride or trifluoromethane sulfonyl chloride or anhydride, in a solvent such as pyridine, tetrahydrofuran, dichloromethane or benzene. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Exposure of 20 to acidic conditions would then afford ring closure to give 18. Suitable conditions would be the use of an acid such as p-toluenesulfonic acid, methanesulfonic acid or camphorsulfonic acid in a solvent such as dichloromethane, benzene, toluene or tetrahydrofuran. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
An alternative route to 18 is shown in Scheme 9. Treatment of the previously described compound 21, as taught by H. Fukiumi, M. Sugiyama, T. Sakamoto, Chem. Pharm. Bull., 37(5):1197 (1989), with an organo-metallic reagent such as a Grignard reagent, an alkyl or aryl zinc reagent, an alkyl or aryl lithium reagent in an inert solvent (tetrahydrofuran, diethylether) under an inert atmosphere (nitrogen or argon) at a suitable temperature from 0xc2x0 C. up to reflux temperature of the solvent will then provide the tertiary alcohol 22. Compound 22 may then be subjected to basic conditions to effect ring closure to give the cyclocarbamate derivative 23. Suitable conditions would involve treatment of 22 with a base such as potassium hydroxide in a solvent such as ethanol or potassium t-butoxide in tetrahydrofuran The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. Compound 23 may then be converted to the brominated derivative 24. Suitable conditions would be treatment with bromine or N-bromosuccinimide in a solvent such as dichloromethane, tetrahydrofuran or acetic acid. The reaction can be carried out in an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent in the presence of an additive such as silica gel. Subsequent reaction of 24 with an aryl or heteroaryl boronic acid boronic acid anhydride or trialkyl stannane then provides access to the desired biaryl compound 18. The reaction can be carried out in a solvent such as acetone, ethanol, benzene, toluene or tetrahydrofuran, under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent, in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate. 
Alternatively, 23 (Scheme 10) may be treated at low temperature with a reagent such as an alkyl lithium or lithium amide in an inert solvent such as tetrahydrofuran, and then converted to a boronic acid 25 (M=B(OH)2) under the action of trimethyl or triisopropyl borate, or into a stannane via reaction with trimethyltin chloride or bis(trimethyltin). Subsequent reaction of 25 with an aryl or heteroaryl bromide or iodide in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate, would then effect conversion into the desired thiophene cyclocarbamate 18.
C. Method for synthesizing the thiophene thiocyclocarbamate compounds 26 and 27 depicted in Scheme 11 are described below: 
Thiophene thiocyclocarbamates 26 and 27 may be obtained directly by treating 5 and 18 respectively with phosphorus pentasulfide in refluxing pyridine. Alternatively 5 and 18 may be treated with Lawesson""s reagent ([2,4-bis(4-methoxyphenyl)-1,3-dithia-2,4-diphosphetane-2,4-disulfide]) in refluxing pyridine to afford 26 and 27, respectively.
Process for Making Thiazole Cyclocarbamate Derivatives
Methods for preparing the thiazole cyclocarbamate compounds are described below. 
Thus the thiazole 28 was prepared according to a literature procedure, scheme 12 by B. Golankiewicz and P. Januszczyk, Tetrahedron, 41:5989 (1985). Reaction of the amine 28 with a suitable chloroformate or carbonate then gives the protected amine 29. This may be accomplished by reacting compound 28 with a chloroformate or carbonate derivative such as methylchloroformate, ethylchloroformate, allylchloroformate, 2-(trimethylsilyl)ethylchloroformate or di-tert-butyldicarbonate in a solvent such as dichloromethane, THF, benzene, xylene or pyridine. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0 xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Exposure of compound 29 to an organo-metallic reagent such as a Grignard reagent, an alkyl or aryl-zinc reagent, an alkyl or aryl lithium reagent in an inert solvent (THF, diethyl ether) under an inert atmosphere (nitrogen or argon) at a suitable temperature from 0xc2x0 C. up to the reflux temperature of the solvent will then provide the alcohol 30. Compound 30 may then be exposed to basic conditions to effect ring closure to give the cyclocarbamate derivative 31. Suitable conditions would involve treatment of compound 30 with a base such as potassium hydroxide in a solvent such as ethanol. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
Alternatively the carbamate protecting group present in compound 30 may be removed under conditions appropriate for its removal to afford compound 32 as taught by T. W. Greene and P. G. M. Wuts, Protective Groups in Organic Synthesis, second ed., Wiley-Interscience (1991). Subsequent ring closure of compound 32 with a reagent such as phosgene, carbonyl diimidazole or dimethyl carbonate in an appropriate solvent (THF, dichloromethane, benzene, etc) will also provide access to compound 31. 
Alternatively, if compound 30 is a tertiary alcohol then it may be dehydrated to afford the isopropene derivative 33, scheme 3. Suitable conditions for the dehydration would the use of a reagent such as acetic anhydride, methanesulfonyl chloride, p-toluenesulfonyl chloride or trifluoromethane sulfonyl chloride or anhydride, in a solvent such as pyridine, THF, dichloromethane or benzene. The reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent and may require the presence of a base such as 4-dimethylaminopyridine, triethylamine, pyridine or di-isopropyl ethylamine. Exposure of compound 33 to acidic conditions would then afford ring closure to give compound 31. Suitable conditions would be the use of an acid such as p-toluenesulfonic acid, methanesulfonic acid or camphorsulfonic acid in a solvent such as dichloromethane, benzene, toluene or THF and the reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent. 
Compound 31 may then be converted into the bromide 34, scheme 15. Suitable conditions would be exposure to bromine or N-bromosuccinimide in a solvent such as dichloromethane, THF or acetic acid, the reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent in the presence of an additive such as silica gel. Subsequent reaction of compound 34 with an aryl or heteroaryl boronic acid, boronic acid anhydride or trialkyl stannane then provides access to the desired biaryl compound 35. The reaction can be carried out in a solvent such as acetone, ethanol, benzene, toluene or THF, under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent, in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate. 
Alternatively compound 31 may be treated at low temperature with a reagent such as an alkyl lithium or lithium amide in an inert solvent such as THF, and then converted into a boronic acid (M=B(OH)2) 36 under the action of trimethyl or triisopropyl borate, or into a stannane under the action of trimethyltin chloride or bis(trimethyltin), Scheme 16. Subsequent reaction with an aryl or heteroaryl bromide or iodide in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate would then effect conversion into the desired compound 35.
Process for Making Amide Thiophene Derivatives
A method for preparing thiophene derivatives is described below, scheme 17. 
Thus the amine 37 is converted into a carbamate, such as a tert-butyl carbamate as described in scheme 1 for the preparation of compound 2. Hydrolysis of the ester 38 under basic conditions, for example lithium or sodium hydroxide in THF or methanol at room temperature then gives the acid 39. Conversion of the acid 39 into the acid chloride 40 is accomplished under standard conditions, thionyl chloride or oxalyl chloride either neat or in the presence of a solvent such as dichloromethane and an additive such as a catalytic amount of N,N-dimethylformamide. Compound 40 is then reacted with diazomethane or trimethylsilyldiazomethane in an inert solvent such as THF or dichloromethane, and the product diazoketone 41 is then rearranged in the presence of silver (I) oxide to afford the acid 42. Treatment of compound 42 under conditions that specifically remove the protecting carbamate functionality, for example acidic conditions, will then affect cyclization to give compound 43. Reaction of compound 43 with an alkylating agent such as an alkyl iodide, bromide, tosylate or mesylate, or a bis-alkyl iodide, bromide, tosylate or mesylate, under basic conditions, for example butyl lithium in the presence of N,N,N,N-tetramethylene diamine in a solvent such as THF under an inert atmosphere (nitrogen or argon) at a temperature between xe2x88x9278xc2x0 C. and the boiling point of the solvent, will then afford the alkylated derivative 44.
Process for Making Thiazole Derivatives
A method for preparing thiazole derivatives is described below, scheme 18. 
Hydrolysis of the ester 29 under basic conditions, for example lithium or sodium hydroxide in THF or methanol at room temperature then gives the acid 45. Conversion of the acid 45 into the acid chloride 46 is accomplished under standard conditions, for example thionyl chloride or oxalyl chloride either neat or in the presence of a solvent such as dichloromethane and an additive such as a catalytic amount of N,N-dimethylformamide. Compound 46 is then reacted with diazomethane or trimethylsilyldiazomethane in an inert solvent such as THF or dichloromethane, and the product diazoketone 47 is then rearranged in the presence of silver (I) oxide to afford the acid 48. Treatment of compound 48 under conditions that specifically remove the protecting carbamate functionality, for example acidic conditions, will then affect cyclization to give the heterocycle 49. Reaction of compound 49 with an alkylating agent such as an alkyl iodide, bromide, tosylate or mesylate, or a bis-alkyl iodide, bromide, tosylate or mesylate, under basic conditions, for example butyl lithium in the presence of N,N,N,N-tetramethylene diamine in a solvent such as THF under an inert atmosphere (nitrogen or argon) at a temperature between xe2x88x9278xc2x0 C. and the boiling point of the solvent, will then afford the alkylated heterocycle 50. Compound 50 may then be converted into the bromide 51. Suitable conditions would be exposure to bromine or N-bromosuccinimide in a solvent such as dichloromethane, TMF or acetic acid, the reaction can be carried out under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent in the presence of an additive such as silica gel. Subsequent reaction of compound 51 with an aryl or heteroaryl boronic acid, boronic acid anhydride or trialkyl stannane then provides access to the desired biaryl compound 52. The reaction can be carried out in a solvent such as acetone, ethanol, benzene, toluene or THF, under an inert atmosphere (nitrogen or argon) from 0xc2x0 C. up to the reflux temperature of the solvent, in the presence of a palladium catalyst such as tetrakis(triphenylphosphine)palladium (0) or palladium acetate and may require an additive such as sodium carbonate, cesium fluoride or potassium phosphate. The thione derivative, compound 53, may be obtained directly by treating 52 with phosphorus pentasulfide in refluxing pyridine. Alternatively 52 may be treated with Lawesson""s reagent in refluxing pyridine to afford 53.
The anti-progestin compounds of the formulations of the present invention can be used in the form of salts derived from pharmaceutically or physiologically acceptable acids or bases. These salts include, but are not limited to, the following salts with inorganic acids such as hydrochloric acid, sulfuric acid, nitric acid, phosphoric acid and, as the case may be, such organic acids as acetic acid, oxalic acid, succinic acid, and maleic acid. Other salts include salts with alkali metals or alkaline earth metals, such as sodium, potassium, calcium or magnesium in the form of esters, carbamates and other conventional xe2x80x9cpro-drugxe2x80x9d forms, which, when administered in such form, convert to the active moiety in vivo.
These methods of treatment may be used for contraception or for the treatment and/or prevention of secondary amenorrhea, dysfunctional bleeding, uterine leiomyomata, endometriosis; polycystic ovary syndrome, carcinomas and adenocarcinomas of the endometrium, ovary, breast, colon, prostate, or minimization of side effects or cyclic menstrual bleeding. Additional uses of the invention include stimulation of food intake.
When the combined compounds are employed for the utilities described above, they may be combined with one or more pharmaceutically acceptable carriers or excipients, for example, solvents, diluents and the like, and may be administered orally in such forms as tablets, capsules, dispersible powders, granules, or suspensions containing, for example, from about 0.05 to 5% of suspending agent, syrups containing, for example, from about 10 to 50% of sugar, and elixirs containing, for example, from about 20 to 50% ethanol, and the like, or parenterally in the form of sterile injectable solutions or suspensions containing from about 0.05 to 5% suspending agent in an isotonic medium. Such pharmaceutical preparations may contain, for example, from about 25 to about 90% of the active ingredient in combination with the carrier, more usually between about 5% and 60% by weight.
These active compounds may be administered orally as well as by intravenous, intramuscular, or subcutaneous routes. Solid carriers include starch, lactose, dicalcium phosphate, microcrystalline cellulose, sucrose and kaolin, while liquid carriers include sterile water, polyethylene glycols, non-ionic surfactants and edible oils such as corn, peanut and sesame oils, as are appropriate to the nature of the active ingredient and the particular form of administration desired. Adjuvents customarily employed in the preparation of pharmaceutical compositions may be advantageously included, such as flavoring agents, coloring agents, preserving agents, and antioxidants, for example, vitamin E, ascorbic acid, BHT and BHA.
The preferred pharmaceutical compositions from the standpoint of ease of preparation and administration are solid compositions, particularly tablets and hard-filled or liquid-filled capsules. Oral administration of the compounds is preferred.
These active compounds may also be administered parenterally or intraperitoneally. Solutions or suspensions of these active compounds as a free base or pharmacologically acceptable salt can be prepared in water suitably mixed with a surfactant such as hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid, polyethylene glycols and mixtures thereof in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.
The pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases, the form must be sterile and must be fluid to the extent that easy syringe ability exits. It must be stable under conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms such as bacterial and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol (e.g., glycerol, propylene glycol and liquid polyethylene glycol), suitable mixtures thereof and vegetable oil.
The following non-limiting examples are illustrative of exemplary compound 5.